- Email: [email protected]
Pharmacotherapy of Late-Life Mental Disorders: Is There Anything New Under the Sun?
2017 AAGP Annual Meeting Abstract: With the Baby Boomers aging, the misuse of substances has increased in frequency compared with previous cohorts of aging adults. Presenters will include addiction psychiatrists and geriatric psychiatrists who will discuss the demographic shifts in substance use among older adults as well as the physiological effects of commonly misused substances in the aging brain. The various pharmacologic options for the management of common substance use disorders will be covered, including possible treatments on the horizon. Potential contraindications to these pharmacologic agents in older adults will also be discussed. Faculty Disclosures: Marie DeWitt Nothing to disclose Daryl Shorter Nothing to disclose
PHARMACOTHERAPY OF LATE-LIFE MENTAL DISORDERS: IS THERE ANYTHING NEW UNDER THE SUN? Session 403 Benoit H. Mulsant1; Martha Sajatovic2; Eric Lenze3 1
University of Toronto, Toronto, ON, Canada Case Western Reserve University, Cleveland, OH 3 Washington University School of Medicine, St Louis, MO 2
Abstract: During the past decade, the traditional classification of psychotropic medications as antidepressants, antipsychotics, mood stabilizers, anxiolytics, and hypnotics has been questioned. Antipsychotics are commonly used as first-line treatment for late-life mood disorders or insomnia and antidepressants are used as first-line treatment for late-life anxiety disorders or psychosis associated with dementia. However, patients and their caregivers may be confused or distraught when they find out that they have been prescribed “a second-generation antipsychotic”, in the absence of psychotic symptoms or a serotonergic “antidepressant” in the absence of depressive symptoms. In 2014, a collaborative of five American, Asian, European, and international psychopharmacology societies proposed a new nomenclature for psychotropic drugs based on their pharmacodynamic properties rather than on target symptoms. Three presentations will review the rationale and evidence for and against using this new model in the pharmacotherapy of late-life mental disorders, based on the evidence supporting or challenging the use of these psychotropic medications for non-traditional indications. The first presentation will discuss drugs that are primarily monoamine agonists (“antidepressants” and “stimulants”); the second presentations will discuss dopamine blockers (“antipsychotics”) and second messenger modifiers (“mood stabilizers); the third presentations will discuss gabaergic agonists (“anxiolytics” or “hypnotics”). More than one-third of the symposium will be dedicated for discussion among the presenters and the audience. Faculty Disclosures: Benoit H. Mulsant Research Support: Bristol-Myers Squibb—Medications for a NIH-funded clinical trial Research Support: Eli Lilli—Medications for a NIH-funded clinical trial Research Support: HAPPYneuron—Software used in study funded by CAMH Foundation Shareholder: General Electric—Less than $5,000 Research Support: Pfizer—Medications for a NIH-funded clinical trial Research Support: Capital Solution Design LLC—Software used in study funded by CAMH Foundation Martha Sajatovic Other: Springer Press, Johns Hopkins University Press, Oxford Press, UpToDate, Lexicomp—Royalties Other: American Physician’s Institute, MCM Education, CMEology—CME activities Research Support: Pfizer, Merck, Ortho-McNeil Janssen, Janssen, Reuter Foundation, Woodruff Foundation, Reinberger Foundation, National Institute of Health (NIH), Centers for Disease Control and Prevention (CDC)—Research to my institution Consultant: Bracket, Prophase, Otsuka, Pfizer, Sunovion, Neurocrine—N/A
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Am J Geriatr Psychiatry 25:3S, Supplement 1
2017 AAGP Annual Meeting Eric Lenze Research Support: Lundbeck—co-funding for IISR Research Support: Takeda—co-funding for IISR
THE WECAREADVISOR™: A WEB-BASED TOOL TO HELP FAMILY CAREGIVERS MANAGE THE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA Session 404 Helen C. Kales1; Laura N. Gitlin2; Constantine G. Lyketsos2 1
University of Michigan, Ann Arbor, MI Johns Hopkins Medicine, Baltimore, MD
2
Abstract: One of the biggest challenges in the day to day management of dementia is the behavioral symptoms that go hand and hand with the illness including agitation, anxiety, depression, aggression, sleep problems and socially inappropriate behaviors. These symptoms are associated with many of the negative outcomes of dementia including hospitalizations, increased placement in nursing homes, caregiver stress, depression lost income and decreased quality of life. The most common way to handle dementia-related behaviors is by using psychiatric medications like antipsychotics. There are often more effective and safer ways to manage behaviors, but caregivers lack access to learning these strategies. Family caregivers are in desperate need of help. While a good number of scientific trials have found that caregiver training is highly effective, most caregivers don’t have access to or time to attend such programs. Seeing this “translation gap”, Drs. Kales, Gitlin and Lyketsos spent more than a year in a National Institute of Nursing Research funded R01 working with family caregivers themselves to see what they wanted in a dementia care tool. The WeCareAdvisor™ uses the DICE approach, a systematic approach created by Kales, Gitlin and Lyketsos. The DICE approach is intended to guide caregivers through a reasoning process that determines the context of behaviors and then provides tailored strategies aimed at reducing problem behaviors like agitation, aggression, depression, anxiety, and wandering while also reducing caregiver stress. In this symposium, the investigators will present: 1) information describing the creation of the WeCareAdvisor™ tool; 2) results from the randomized controlled trial of 60 caregiver-person with dementia dyads; and 3) “lessons learned” to be used going forward in the next version of the tool. Faculty Disclosures: Helen C. Kales Nothing to disclose Laura N. Gitlin No Answer Constantine G. Lyketsos Research Support: NIMH, NIA, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, Glaxo-Smith-Kline, Eisai, Pfizer, Astra-Zeneca, Lilly, Ortho-McNeil, Bristol-Myers, Novartis, National Football League, Elan—Research support Consultant: Astra-Zeneca, Glaxo-Smith Kline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Pfizer, Genentech, Elan, NFL Players Association, NFL Benefits Office, Avanir, Zinfandel, BMS, Abvie, Janssen, Orion, Otsuka, Astellas—Consultant or advisor Other: Pfizer, Forest, Glaxo-Smith Kline, Health Monitor—Travel support
FORENSICS IN GERIATRIC PSYCHIATRY FELLOWSHIP: EVOLUTION AND VALUE Session 406 Stephen Read1; Aaron Kaufman2; Taya Varteresian2; Aviva Bobb3 1
UCLA, San Pedro, CA LA County, Los Angeles, CA 3 ARC, Los Angeles, CA 2
Am J Geriatr Psychiatry 25:3S, Supplement 1
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PHARMACOTHERAPY OF LATE-LIFE MENTAL DISORDERS: IS THERE ANYTHING NEW UNDER THE SUN? Session 403 Benoit H. Mulsant1; Martha Sajatovic2; Eric Lenze3 1
University of Toronto, Toronto, ON, Canada Case Western Reserve University, Cleveland, OH 3 Washington University School of Medicine, St Louis, MO 2
Abstract: During the past decade, the traditional classification of psychotropic medications as antidepressants, antipsychotics, mood stabilizers, anxiolytics, and hypnotics has been questioned. Antipsychotics are commonly used as first-line treatment for late-life mood disorders or insomnia and antidepressants are used as first-line treatment for late-life anxiety disorders or psychosis associated with dementia. However, patients and their caregivers may be confused or distraught when they find out that they have been prescribed “a second-generation antipsychotic”, in the absence of psychotic symptoms or a serotonergic “antidepressant” in the absence of depressive symptoms. In 2014, a collaborative of five American, Asian, European, and international psychopharmacology societies proposed a new nomenclature for psychotropic drugs based on their pharmacodynamic properties rather than on target symptoms. Three presentations will review the rationale and evidence for and against using this new model in the pharmacotherapy of late-life mental disorders, based on the evidence supporting or challenging the use of these psychotropic medications for non-traditional indications. The first presentation will discuss drugs that are primarily monoamine agonists (“antidepressants” and “stimulants”); the second presentations will discuss dopamine blockers (“antipsychotics”) and second messenger modifiers (“mood stabilizers); the third presentations will discuss gabaergic agonists (“anxiolytics” or “hypnotics”). More than one-third of the symposium will be dedicated for discussion among the presenters and the audience. Faculty Disclosures: Benoit H. Mulsant Research Support: Bristol-Myers Squibb—Medications for a NIH-funded clinical trial Research Support: Eli Lilli—Medications for a NIH-funded clinical trial Research Support: HAPPYneuron—Software used in study funded by CAMH Foundation Shareholder: General Electric—Less than $5,000 Research Support: Pfizer—Medications for a NIH-funded clinical trial Research Support: Capital Solution Design LLC—Software used in study funded by CAMH Foundation Martha Sajatovic Other: Springer Press, Johns Hopkins University Press, Oxford Press, UpToDate, Lexicomp—Royalties Other: American Physician’s Institute, MCM Education, CMEology—CME activities Research Support: Pfizer, Merck, Ortho-McNeil Janssen, Janssen, Reuter Foundation, Woodruff Foundation, Reinberger Foundation, National Institute of Health (NIH), Centers for Disease Control and Prevention (CDC)—Research to my institution Consultant: Bracket, Prophase, Otsuka, Pfizer, Sunovion, Neurocrine—N/A
S30
Am J Geriatr Psychiatry 25:3S, Supplement 1
2017 AAGP Annual Meeting Eric Lenze Research Support: Lundbeck—co-funding for IISR Research Support: Takeda—co-funding for IISR
THE WECAREADVISOR™: A WEB-BASED TOOL TO HELP FAMILY CAREGIVERS MANAGE THE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA Session 404 Helen C. Kales1; Laura N. Gitlin2; Constantine G. Lyketsos2 1
University of Michigan, Ann Arbor, MI Johns Hopkins Medicine, Baltimore, MD
2
Abstract: One of the biggest challenges in the day to day management of dementia is the behavioral symptoms that go hand and hand with the illness including agitation, anxiety, depression, aggression, sleep problems and socially inappropriate behaviors. These symptoms are associated with many of the negative outcomes of dementia including hospitalizations, increased placement in nursing homes, caregiver stress, depression lost income and decreased quality of life. The most common way to handle dementia-related behaviors is by using psychiatric medications like antipsychotics. There are often more effective and safer ways to manage behaviors, but caregivers lack access to learning these strategies. Family caregivers are in desperate need of help. While a good number of scientific trials have found that caregiver training is highly effective, most caregivers don’t have access to or time to attend such programs. Seeing this “translation gap”, Drs. Kales, Gitlin and Lyketsos spent more than a year in a National Institute of Nursing Research funded R01 working with family caregivers themselves to see what they wanted in a dementia care tool. The WeCareAdvisor™ uses the DICE approach, a systematic approach created by Kales, Gitlin and Lyketsos. The DICE approach is intended to guide caregivers through a reasoning process that determines the context of behaviors and then provides tailored strategies aimed at reducing problem behaviors like agitation, aggression, depression, anxiety, and wandering while also reducing caregiver stress. In this symposium, the investigators will present: 1) information describing the creation of the WeCareAdvisor™ tool; 2) results from the randomized controlled trial of 60 caregiver-person with dementia dyads; and 3) “lessons learned” to be used going forward in the next version of the tool. Faculty Disclosures: Helen C. Kales Nothing to disclose Laura N. Gitlin No Answer Constantine G. Lyketsos Research Support: NIMH, NIA, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, Glaxo-Smith-Kline, Eisai, Pfizer, Astra-Zeneca, Lilly, Ortho-McNeil, Bristol-Myers, Novartis, National Football League, Elan—Research support Consultant: Astra-Zeneca, Glaxo-Smith Kline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Pfizer, Genentech, Elan, NFL Players Association, NFL Benefits Office, Avanir, Zinfandel, BMS, Abvie, Janssen, Orion, Otsuka, Astellas—Consultant or advisor Other: Pfizer, Forest, Glaxo-Smith Kline, Health Monitor—Travel support
FORENSICS IN GERIATRIC PSYCHIATRY FELLOWSHIP: EVOLUTION AND VALUE Session 406 Stephen Read1; Aaron Kaufman2; Taya Varteresian2; Aviva Bobb3 1
UCLA, San Pedro, CA LA County, Los Angeles, CA 3 ARC, Los Angeles, CA 2
Am J Geriatr Psychiatry 25:3S, Supplement 1
S31